Cingöz İlker Deniz
Department of Neurosurgery, Faculty of Medicine, Usak University, Usak, TUR.
Cureus. 2023 Jan 9;15(1):e33542. doi: 10.7759/cureus.33542. eCollection 2023 Jan.
Background A limited number of studies are available in the literature on the surgical treatment of brucellosis-related spondylodiscitis. This study aimed to define and discuss the role of surgery in brucellosis-related spondylodiscitis. Methodology A total of 28 patients who underwent surgical treatment due to brucellosis-related spondylodiscitis between February 2021 and August 2022 were included in this study. Medical records, radiological images, and laboratory data were collected. Surgical results were evaluated according to the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, clinical findings, postoperative radiological imaging findings, and complications were evaluated. Results In total, 16 of the patients included in the study were male and 12 were female, with a mean age of 56.4 ± 7.2 years. The mean follow-up duration was 11.8 ± 5.4 months. Brucellosis involvement was in the lumbosacral region in all patients. Overall, 21 patients had a neurological deficit in the preoperative period. Posterior stabilization and fusion were done in 20 (71.4%) patients, while simple laminectomy (decompression) and debridement were done in eight (28.6%) patients. There was a decrease in the pain in the lower back and leg in all patients in the postoperative period. Neurological recovery was achieved in 18 patients with a neurological deficit. Two patients underwent wound drainage in the postoperative period. The patient who had morbid obesity and comorbidities died in the postoperative period. ESR and CRP levels returned to normal at the end of the six-month follow-up. There was a significant recovery in VAS and ODI scores (p < 0.05). In total, 24 (85.4%) patients were considered fully recovered both radiologically and clinically at the end of the follow-up. Conclusions Although long-term and specific antibiotic treatment constitute the main treatment in brucellosis-related spondylodiscitis, debridement, decompression, and stabilization (when required) of infection with a focus on neurological deficits and instability formation and non-stop severe pain are effective and safe treatment options.
关于布鲁氏菌病相关性脊椎椎间盘炎手术治疗的文献研究数量有限。本研究旨在明确并探讨手术在布鲁氏菌病相关性脊椎椎间盘炎中的作用。方法：本研究纳入了2021年2月至2022年8月期间因布鲁氏菌病相关性脊椎椎间盘炎接受手术治疗的28例患者。收集了病历、放射影像和实验室数据。根据视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估手术结果。评估了C反应蛋白（CRP）和红细胞沉降率（ESR）水平、临床症状、术后放射影像学检查结果及并发症。结果：本研究纳入的患者中，男性16例，女性12例，平均年龄56.4±7.2岁。平均随访时间为11.8±5.4个月。所有患者的布鲁氏菌病均累及腰骶部。总体而言，21例患者术前存在神经功能缺损。20例（71.4%）患者接受了后路稳定融合术，8例（28.6%）患者接受了单纯椎板切除术（减压）和清创术。所有患者术后下背部和腿部疼痛均减轻。18例有神经功能缺损的患者实现了神经功能恢复。2例患者术后进行了伤口引流。1例患有病态肥胖和多种合并症的患者术后死亡。随访6个月结束时，ESR和CRP水平恢复正常。VAS和ODI评分有显著改善（p<0.05）。随访结束时，共有24例（85.4%）患者在放射学和临床上均被认为完全康复。结论：尽管长期和特异性抗生素治疗是布鲁氏菌病相关性脊椎椎间盘炎的主要治疗方法，但针对神经功能缺损、不稳定形成及持续严重疼痛进行清创、减压和（必要时）稳定手术是有效且安全的治疗选择。
